Provider Demographics
NPI:1154749877
Name:BAKKER, CAROL ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:BAKKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8616 COLUMBIA AVE
Mailing Address - Street 2:SCHOOL TOWN OF MUNSTER
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-836-9111
Mailing Address - Fax:219-836-3215
Practice Address - Street 1:8616 COLUMBIA AVE
Practice Address - Street 2:WILBUR WRIGHT MIDDLE SCHOOL
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-836-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28083454A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse